Dr. Carl Sagan
March 10, 1996
Four times now I have looked Death in the face. And four times Death has averted his gaze and let me pass. Eventually, of course, Death will claim me–as he does each of us. It’s only a question of when. And how.
I’ve learned much from our confrontations—especially about the beauty and sweet poignancy of life, about the preciousness of friends and family, about the transforming power of love. In fact, almost dying is such a positive, character-building experience that I’d recommend it to everybody—except, of course, for the irreducible and essential element of risk.
I would love to believe that when I die I will live again, that some thinking, feeling, remembering part of me will continue. But as much as I want to believe that, and despite the ancient and worldwide cultural traditions that assert and afterlife, I know of nothing to suggest that it is more than wishful thinking.
I want to grow really old with my wife, Annie, whom I dearly love. I want to see my younger children grow up and play a role in their character and intellectual development. I want to meet still unconceived grandchildren. There are scientific problems whose outcomes I long to witness—such as the exploration of many of the worlds in our solar system and the search for life elsewhere. I want to learn how major trends in human history, both hopeful and worrisome, work themselves out: the dangers and promise of our technology, say; the emancipation of women; the growing political, economic and technological ascendancy of China; interstellar flight.
If there were life after death, I might, no matter when I die, satisfy most of these deep curiosities and longings. But if death is nothing more than an endless, dreamless sleep, this is a forlorn hope. Maybe this perspective has given me a little extra motivation to stay alive.
The world is so exquisite, with so much love and moral depth, that there is no reason to deceive ourselves with pretty stories for which there’s little good evidence. Far better, it seems to me, in our vulnerability, is to look death in the eye and to be grateful every day for the brief but magnificent opportunity that life provides.
Near my shaving mirror, so I see it every morning, is a framed postcard. On the back is a penciled message to a Mr. James Day in Swansea Valley, Wales. It reads:
Just a line to show that I am alive & kicking and going grand. It’s a treat.
It’s signed with the almost-indecipherable initials of one William John Rogers. On the front is a color photo of a sleek, four-funneled steamer captioned "White Star Liner Titanic." The postmark was imprinted the day before the great ship went down, losing more than 1500 lives, including Mr. Rogers’. Annie and I display the postcard for a reason. We know that "going grand" can be the most temporary and illusory state. So it was with us.
We were in apparently good heath, our children thriving. We were writing books, embarking on ambitious new television and motion-picture projects, lecturing, and I continued to be engaged in the most exciting scientific research.
Standing by the framed postcard one morning late in 1994, Annie noticed an ugly black-and-blue mark on my arm that had been there for many weeks. "Why hasn’t it gone away?" she asked. At her insistence, I somewhat reluctantly (black-and-blue marks can’t be serious, can they?) went to the doctor to have some routine blood tests.
We heard from him a few days later when we were in Austin, Tex. He was troubled. There clearly was some lab mix-up. The analysis showed the blood of a very sick person. "Please," he urged, "get retested right away." I did. There had been no mistake.
My red cells, which carry oxygen all over the body, and my white cells, which fight disease, were both severely depleted. The most likely explanation: that there was a problem with the stem cells, the common ancestors of both white and red blood cells, which are generated in the bone marrow. The diagnosis was confirmed by experts in the field. I had a disease I had never heard of before: myelodysplasia. Its origin is unknown. If I did nothing, I was astonished to learn, my chances were zero. I’d be dead in six months. I was still feeling fine—perhaps a little lightheaded from time to time. I was active and productive. The notion that I was on death’s doorstep seemed a grotesque joke.
There was only one known means of treatment that might generate a cure: a bone-marrow transplant. But that would only work if I could find a compatible donor. Even then, my immune system would have to be entirely suppressed so the donor’s bone marrow wouldn’t be rejected by my body. However, a severely suppressed immune system might kill me in several other ways—for example,. By so limiting my resistance to disease that I might fall prey to any passing microbe. Briefly I thought about doing nothing and waiting for advanced in medical research to find a new cure. But that was the slimmest of hopes.
All our lines of research as to where to go converged on the Fred Hutchinson Cancer Research Center in Seattle, one of the premier institutions for bone-marrow transplants in the world. It is where many experts in the field hang their hats—among them E. Donnall Thomas, the winner of the 1990 Nobel Prize in Physiology or Medicine for perfecting the present techniques of bone-marrow transplantation. The high competence of the doctors and nurses, the excellence of their care, fully justified the advice we were given to be treated at "the Hutch."
The first step was to see if a compatible donor could be found. Some people never find one. Annie and I called my only sibling—my younger sister, Cari. I found myself allusive and indirect. Cari didn’t even know I was ill. Before I could get to the point, she said, "You got it. Whatever it is…liver…lung…It’s yours." I still get a lump in my throat every time I think of Cari’s generosity.
But there was of course no guarantee that her bone marrow would be compatible with mine. She underwent a series of tests, and one after another, all six compatibility factors matched mine. She was a perfect match. I was incredibly lucky.
But "lucky" is a comparative term. Even with the perfect compatibility, my over all chances of a cure were something like 30 percent. That’s like playing Russian Roulette with four cartridges instead of one in the cylinder. But it was by far the best chance that I had, and I had faced longer odds in the past.
Our whole family moved to Seattle, including Annie’s parents. We enjoyed a constant flow of visitors—grown-up children, my grandson, other relatives and friends—both when I was in the hospital and when I was an outpatient. I’m sure that the support and love I received, especially from Annie, tilted the odds in my favor.
There were, as you might guess, many scary aspects. I remember one night, on medical instructions, getting up at 2 a.m. and opening the first of 12 plastic containers of busulfan tablets, a potent chemotherapeutic agent. The bag read:
Dispose of as BIOHAZARD
One after another, I popped 72 of these pills. It was a lethal amount. If I was not to have a bone-marrow transplant soon after, this immune-suppression therapy by itself would have killed me. It was like taking a fatal dose of arsenic or cyanide, hoping that the right antidote would be supplied in time.
The drugs to suppress my immune system had a few direct effects. I was in a continuous state of moderate nausea, but it was controlled by other drugs and not so bad that I couldn’t get some work done. I lost almost all of my hair—which, along with a later weight loss, gave me a somewhat cadaverous appearance. But I was much buoyed when our 4-year-old son, Sam, looked me over and said, "Nice haircut, Dad." And then, "I don’t know anything about you being sick. All I know is, you’re gonna get better."
I had expected the transplant itself to be enormously painful. It was nothing of the sort. It was just like a blood transfusion, with my sister’s bone marrow cells on their own finding their way to my own bone marrow. Some aspects of the treatment were extremely painful, but there’s a kind of traumatic amnesia that happens, so that when it’s all over you’ve almost forgotten the pain. The Hutch has an enlightened policy of self-administered anti-pain drugs, including morphine derivatives, so that I could immediately deal with severe pain. It made the whole experience much more bearable.
At the end of the treatment, my red and white cells were mainly Cari’s. Their sex chromosomes were XX, instead of the rest of my body’s XY. I had female red and white blood cells and platelets circulating through my body. I kept waiting for some of Cari’s interests to assert themselves—a passion for riding horses, say, or for seeing half a dozen Broadway plays at one clip—but it never happened.
Annie and Cari saved my life. I’ll always be grateful to them for their love and compassion. After being released from the hospital, I needed all sorts of medical attention, including drugs administered several times a day through a porthole in my vena cava. Annie was my "designated caregiver"—administrating medication day and night, changing dressings, checking my vital signs and providing essential support. People who arrives at the hospital alone are said, understandably, to have much poorer chances.
I was, for the moment, spared because of medical research. Some of it was applied research, designed to help cure or mitigate killer diseases directly. Some of it was basic research, designed only to understand how living things work—but with ultimately unpredictable practical benefits, serendipitious results.
I was spared also by the medical insurance provided by Cornell University and (As a spousal benefit via Annie) by the Writers Guild of America—the organization of writers for movies, television, etc. There are tens of missions in America without such medical insurance. What would we have done in their shoes?
In my writings, I have tired to show how closely related we are to other animals, how cruel it is to gratuitously inflict pain on them, and how morally bankrupt it is to slaughter them, say, to manufacture lipstick. But still, as Dr. Thomas put it in his Nobel Prize lecture, "The marrow grafting could not have reached clinical application without animal research, first in in-bred rodents and then in out-bred species, particularly the dog." I remain very conflicted in this issue. I would not be alive today if not for the research on animals.
So life returned to normal. Annie and our family returned to Ithaca, N.Y., where we live. I completed several research projects and did the final proofing of my book The Demon Haunted World: Science as a Candle in the Dark. We met with Bob Zemeckis, the new director of the Warner Brothers movie Contact, based on my novel, which we are co-producing. We began negotiating on some new television and movie projects. I participated in the early stages of the encounter with Jupiter of the Galileo spacecraft.
But if there was one lesson I keenly learned, it is that the future is unpredictable. As William John Rogers, cheerfully penciling his postcard in the brisk air of the North Atlantic, ruefully discovered, there is no telling what even the immediate future holds. And so, after being home for months—my hair growing back, my weight back to normal, my white and red cells counts in the normal range and me feeling absolutely splendid—another routine blood test took the wind out of my sails.
"I’m afraid I have some bad news for you," the physician said. My bone marrow had revealed the presence of a new population of dangerous rapidly reproducing cells. In two days, the whole family was back in Seattle. I’m writing this article from my hospital bed at the Hutch. Through a new experimental procedure, it was determined that these anomalous cells lack an enzyme that would protect them from two standard chemotherapeutic agents—chemicals I hadn’t been given before. After one round with these agents, no anomalous cells—not one—could be found in my marrow. To mop up and stragglers (they can be a few but very fast growing), I’m in the midst of two more rounds of chemotherapy—probably to be topped off with some more cells from my sister. Once more, I have a real shot at a complete cure.
We all have a tendency to succumb to a state of despair about the destructiveness and shortsightiveness of the human species. I’ve certainly done my share (and on grounds I still consider well-based). But one of my discoveries during my illness is the extraordinary community of goodness to which people in my situation own their lives.
There are more than 2 million Americans in the National Marrow Donor Program’s volunteer registry, all willing to submit to a somewhat uncomfortable marrow extraction to benefit some unrelated perfect stranger. Millions more contribute blood to the American Red Cross for no financial reward, not even a $5 bill, to save an anonymous life.
Scientists and technicians work for years—against long odds, often for low salaries and never with a guarantee of success. They have many motivations, but one of them is the hope of helping others, of curing diseases, of staving off death. When too much cynicism threatens to engulf us, it is buoying to remember how pervasive goodness is.
Five thousand people prayed for me at an Easter service at the Cathedral of St. John the Divine in New York City, the largest church in Christendom. A Hindu priest described a large prayer vigil for me held on banks of the Ganges. The Imam of North America told be about his prayers for my recovery. Many Christians and Jews wrote me to tell about theirs. While I do not think that, if there is a god, his plan for me will be altered by prayer, I’m more grateful than I can say to those—including so many whom I’ve never met—who have pulled for me during my illness.
Many of them have asked me how it is possible to face death without the certainty of an afterlife. I can only say that it hasn’t been a problem. With reservations about "feeble souls," I hare the view of a hero of mine, Albert Einstein: "I cannot conceive of a god who rewards and punishes his creatures or has a will of the kind that we experience in ourselves. Neither can I—nor would I want to—conceive of an individual that survives his physical death. Let feeble souls, from fear for absurd egotism, cherish such thoughts. I am satisfied with the mystery of the eternity of life and a glimpse of the marvelous structure of the existing world, together with the devoting striving to comprehend a portion, be it ever so tiny, of the Reason that manifests itself in nature."
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